Recent HIV Cases in New Zealand Raise Concerns About Screening Protocols
Two recent cases of HIV transmission from mother to child in New Zealand are prompting a critical look at antenatal screening practices and potential systemic gaps in care.
- Two infants in New Zealand have contracted HIV from their mothers, the first such transmissions in over a decade.
- Experts suggest the mothers, who were from overseas, may have been missed during routine first-trimester screenings.
- Concerns are rising about inconsistent screening policies – some regions use “opt-in” while others use “opt-out” approaches – and potential barriers to testing for migrant mothers.
- Falling overall HIV rates in New Zealand are encouraging, but the cases highlight the need for continued vigilance and equitable access to care.
New Zealand health officials are investigating two recent cases of perinatal HIV transmission – meaning the virus was passed from mother to child during pregnancy, labor, or delivery. This marks the first time such transmissions have occurred in the country in over 17 years, raising questions about potential failures in the healthcare system.
Missed Opportunities and Screening Gaps
The mothers involved were reportedly from overseas and arrived in New Zealand already pregnant, according to Jane Bruning, national co-ordinator of Positive Women Aotearoa, an organization supporting people living with HIV. This timing may have resulted in them missing crucial first-trimester screenings, which are typically when HIV testing is offered. However, Bruning emphasized that HIV blood tests can be administered throughout pregnancy, even during labor, and that intervention is still possible if the virus is detected during childbirth to prevent transmission to the baby.
Bruning expressed concern that healthcare providers caring for the mothers should have considered their country of origin, as some nations have higher HIV prevalence rates. “I’m sure the people who are involved in the babies’ care are feeling terrible about it, but it’s actually not okay that they weren’t tested. There were lots of red lights there for people to have done the HIV test. It’s quite negligent that this has happened,” she stated.
Migrant Status and Barriers to Testing
Experts have noted that migrant mothers may be hesitant to disclose their HIV status due to fears it could negatively impact their visa applications. While New Zealand does not automatically deny visas to individuals with HIV, studies suggest that concerns about discrimination at the border persist.
A Systemic Issue, Not Individual Blame
Dr. Sue McAllister, who leads the HIV Epidemiology Group at the University of Otago, pointed out that a period of zero mother-to-child HIV transmissions followed changes to screening protocols in 2006. She admitted she had anticipated a resurgence of cases, given increasing pressures on the healthcare system. “We were holding our breath,” McAllister said. “Hearing the difficulties about the health system and people accessing midwives and antenatal care and thinking, ‘When is this going to happen?’”
Rising rates of perinatal syphilis – which is tested for alongside HIV – already signaled potential issues with antenatal care and screening. “It is a reminder that it is not the woman, it is the system,” McAllister explained. “It is making sure that midwifery and antenatal care is available for everyone irrespective of where they live and who they are. And also ensuring the midwives know that HIV is still here.”
Inconsistent Screening Policies
Currently, New Zealand lacks national guidance on HIV screening during pregnancy. Some regions employ an “opt-in” policy, requiring explicit consent from expectant mothers, while others use an “opt-out” approach. Research indicates that opt-in policies are associated with lower screening rates. A study published in the New Zealand Medical Journal last year found that opt-in approaches place a greater burden on doctors to proactively offer testing and navigate potential barriers to screening.
In 2022, Auckland and Northland transitioned from opt-in to opt-out screening as part of a trial, resulting in a significant increase in testing rates – from 86% to 98%. Additionally, some regions still require doctors to manually tick an extra box on blood test forms to request HIV screening, a seemingly minor detail that can lead to accidental omissions.
Positive Trends in Overall HIV Rates
Despite these recent cases, the overall picture of HIV prevention in New Zealand remains positive. The latest data from the HIV Epidemiology Group shows 95 new HIV diagnoses last year, down from an average of around 140 in pre-pandemic years. This decline is largely attributed to increased access to pre-exposure medication, rapid testing, and the success of the “U=U” (Undetectable = Untransmittable) campaign, which emphasizes that individuals with an undetectable viral load cannot transmit HIV sexually.
